Die „Opferelektrode“: Eine sichere Option zum Management von Schrittmacherinfektionen bei schrittmacherpflichtigen Patienten

As the number of cardiac implantable electronic devices (CIEDs) increases, so does the need to revise such systems. Pacemaker-dependent patients with a CIED infection are particulary challenging for the attending physician. Here, the CIED cannot simply be removed without replacement. Gold standard therapy is a sufficient, prolonged antibiosis, the complete removal of the CIED, and the installation of a temporary pacemaker system - usually by means of a transvenous probe or epimyocardial probe via thoracotomy. The disadvantages of these therapies are the insecure positioning of the unfixed transvenous or the invasiveness of the epimyocardial probes. Alternatively, we have since 2015 established a concept with the so-called "sacrificial" electrode. For this purpose - during the explantation of the infected CIED - a conventional, transvenous screw electrode is anchored via the subclavian vein in the right ventricle and is then connected cutaneously to an aggregate. If the anti-infective therapy is successful, a new CIED is implanted whenever possible over the contralateral side in the usual way. Stimulation via the sacrificial electrode can be stopped and the probe removed. This method is technically easy to perform and offers great advantages: no dislocation of the probe and maintained patient mobility.